Provider Demographics
NPI:1023788445
Name:LACHANCE, ALEXSANDRA AQUILA (MSN, APRN, FNP-C)
Entity type:Individual
Prefix:
First Name:ALEXSANDRA
Middle Name:AQUILA
Last Name:LACHANCE
Suffix:
Gender:F
Credentials:MSN, APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:24691 SIMMONS DR
Mailing Address - Street 2:
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48374-3070
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2300 HAGGERTY RD STE 2000
Practice Address - Street 2:
Practice Address - City:WEST BLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48323-2189
Practice Address - Country:US
Practice Address - Phone:248-624-9900
Practice Address - Fax:248-896-5450
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-16
Last Update Date:2023-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704297807363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1023788445Medicaid
MI4704297807OtherMI LICENSE